Wiki Arthroscopic knee synovectomy

[such78]

Postoperative diagnosis:
1. right knee lateral and medial meniscal tears
2. synovitis from osteoarthritis
3. patellar, femoral, tibial chondromalacia
4. chondral fragmentation from chronic arthritis

Procedure performed:
1.Right knee lateral and medial partial meniscectomy
2. Major synovectomy.

" Synovitis was seen throughout all three compartments of the patellofemoral and femoral tibial knee joint. The inflammatory tissue was extensively debrided with a shaver"

Can I code this as 29876 with lateral and medial meniscectomy together or is it included in the meniscectomy?

Thank you.

 

[SavCoder]

CPT 29876 cannot be billed in addition to CPT 29880. CPT 29876 would be bundled.

Per CMS NCCI Manual, Ch 4, pg 8, section E, subsection 8, "Arthroscopic synovectomy of the knee may be reported with CPT codes 29875 (Limited synovectomy, “separate procedure”) or 29876 (Major synovectomy of two or three compartments). A synovectomy to “clean up” a joint on which another more extensive procedure is performed is not separately reportable. CPT code 29875 shall not be reported with another arthroscopic knee procedure on the ipsilateral knee. CPT code 29876 may be reported for a medically reasonable and necessary synovectomy with another arthroscopic knee procedure on the ipsilateral knee if the synovectomy is performed in two compartments on which another arthroscopic procedure is not performed. For example, CPT code 29876 shall not be reported for a major synovectomy with CPT code 29880 (Knee arthroscopy, medial AND lateral meniscectomy) on the ipsilateral knee, since knee arthroscopic procedures other than synovectomy are performed in two of the three knee compartments."

Also, AAOS Bulletin April 2005 Accurately Code Knee Procedures explains, "Synovectomy CPT has two codes for synovectomy: 29875 for one compartment and 29876 for two or more compartments. However, this can be misleading. Consider this example: A patient has a medial meniscectomy (29881) along with both medial and lateral synovectomies. Although this is technically a two-compartment synovectomy, the medial synovectomy is included in the code for the medial meniscectomy. Therefore, only a single compartment synovectomy (29875) can be reported."

When counting the number of compartments the synovectomy was performed in, if another procedure is performed in the same compartment, then the synovectomy is bundled.
There are three knee compartments: medial, lateral, and patellofemoral
Since the meniscectomy is performed in 2 compartments, this only leaves 1 compartment left to count towards the synovectomy which would only support billing the limited synovectomy CPT 29875 but CPT 29875 is a "separate procedure" which most payers will bundle as an incidental procedure to the more extensive procedure.
If the provider performed a lateral meniscectomy, CPT 29881, and a synovectomy in the medial and patellofemoral compartments, then CPT 29876 can be billed.

 

[such78]

CPT 29876 cannot be billed in addition to CPT 29880. CPT 29876 would be bundled.

Per CMS NCCI Manual, Ch 4, pg 8, section E, subsection 8, "Arthroscopic synovectomy of the knee may be reported with CPT codes 29875 (Limited synovectomy, “separate procedure”) or 29876 (Major synovectomy of two or three compartments). A synovectomy to “clean up” a joint on which another more extensive procedure is performed is not separately reportable. CPT code 29875 shall not be reported with another arthroscopic knee procedure on the ipsilateral knee. CPT code 29876 may be reported for a medically reasonable and necessary synovectomy with another arthroscopic knee procedure on the ipsilateral knee if the synovectomy is performed in two compartments on which another arthroscopic procedure is not performed. For example, CPT code 29876 shall not be reported for a major synovectomy with CPT code 29880 (Knee arthroscopy, medial AND lateral meniscectomy) on the ipsilateral knee, since knee arthroscopic procedures other than synovectomy are performed in two of the three knee compartments."

Also, AAOS Bulletin April 2005 Accurately Code Knee Procedures explains, "Synovectomy CPT has two codes for synovectomy: 29875 for one compartment and 29876 for two or more compartments. However, this can be misleading. Consider this example: A patient has a medial meniscectomy (29881) along with both medial and lateral synovectomies. Although this is technically a two-compartment synovectomy, the medial synovectomy is included in the code for the medial meniscectomy. Therefore, only a single compartment synovectomy (29875) can be reported."

When counting the number of compartments the synovectomy was performed in, if another procedure is performed in the same compartment, then the synovectomy is bundled.
There are three knee compartments: medial, lateral, and patellofemoral
Since the meniscectomy is performed in 2 compartments, this only leaves 1 compartment left to count towards the synovectomy which would only support billing the limited synovectomy CPT 29875 but CPT 29875 is a "separate procedure" which most payers will bundle as an incidental procedure to the more extensive procedure.
If the provider performed a lateral meniscectomy, CPT 29881, and a synovectomy in the medial and patellofemoral compartments, then CPT 29876 can be billed.

I appreciate your help. Thank you.